Case Vignette:

Mr T was 1 day post open MV repair surgery and complained of central chest pains, radiating to his neck. He was afebrile, haemodynamically stable but slightly breathless on examination. Oxygen saturations were maintained at 97% on room air. Precordial auscultation was unremarkable. His ECG is shown below. What is the diagnosis?


Diagnosis: Acute pericarditis

Characteristic clinical findings in pericarditis include pleuritic chest pain and a pericardial friction rub on auscultation of the left lower sternal border.

Electrocardiography (ECG) may reveal diffuse PR depressions and diffuse ST segment elevations with upward concavity. The ST elevation usually involves more than one coronary vascular territory and there is usually an absence of reciprocal ST changes between leads III and aVL.

In addition to post procedure or post-surgery, as in the case for Mr T, specific causes of pericarditis include the following:

  • Idiopathic causes
  • Infectious conditions, such as viral, bacterial, and tuberculous infections
  • Inflammatory disorders, such as RA, SLE, scleroderma, and rheumatic fever
  • Metabolic disorders, such as renal failure, hypothyroidism, and hypercholesterolemia
  • Cardiovascular disorders, such as acute MI, Dressler syndrome, and aortic dissection
  • Miscellaneous causes, such as iatrogenic, neoplasms, drugs, irradiation and trauma

The most common treatment for these is nonsteroidal anti-inflammatory drugs and colchicine. The complications of pericarditis include effusion, tamponade and myopericarditis. Pericardial effusion may present as a globular heart shadow on chest X-ray. The presence of effusion, constriction or tamponade can be confirmed on echocardiography. Tamponade is potentially life threatening and is diagnosed by the clinical findings of decreased blood pressure, elevated jugular venous pressure, muffled heart sounds on auscultation and pulsus paradoxus.

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